Elsevier

American Heart Journal

Volume 145, Issue 6, June 2003, Pages 1094-1101
American Heart Journal

Clinical investigations: congestive heart failure
C-reactive protein in acute myocardial infarction: association with heart failure

https://doi.org/10.1016/S0002-8703(03)00098-XGet rights and content

Abstract

Background

High C-reactive protein (CRP) levels have been associated with higher mortality rate in patients with acute myocardial infarction (AMI). However, it is not known whether inflammation plays a role in the time-course of heart failure (HF) in this clinical setting. Our aim was to study the nature of the relationship between CRP and HF during AMI.

Methods

This prospective study was carried out in 269 subjects admitted to the hospital for suspected AMI. Of these, 220 had evidence of AMI. The other 49 subjects were studied as controls. CRP was assessed on the first, third, and seventh day after admission.

Results

CRP was significantly higher in the patients with AMI than in the control patients (P = .001) and peaked on the third day. Among the patients with AMI, CRP was higher in patients with HF than in patients without HF (adjusted P = .008, P = .02 and P = .03 on 1st, 3rd, and 7th day, respectively). Prevalence of HF on admission was slightly higher in the subjects with first-day CRP ≥15 mg/L than in those with CRP <15 mg/L, and the between-group difference progressively increased from the first to the seventh day (P < .0001). At multivariable regression analysis, first-day log-CRP was shown to be a strong independent predictor of both HF progression (P < .0001) and left ventricular ejection fraction (P < .0001). One-year total mortality and HF-mortality rates turned out to be higher in the patients with CRP ≥85 mg/L than in those with CRP below that level (P < .0001), and log–third-day CRP was independently associated with 1-year mortality at multivariable analysis (P = .0001).

Conclusions

CRP on admission to hospital is suitable for predicting the time-course of HF in patients with AMI. Peak CRP value is a strong independent predictor of global and HF-mortality during the following year.

Section snippets

Patients

Three hundred and five unselected and consecutive patients admitted to 2 intensive-care units in 2 urban general hospitals for suspected AMI were prospectively studied. Thirty-three patients with preexisting or acute inflammatory process, neoplastic disease, or incomplete data collection, and 3 patients who died within 3 days after admission were excluded. Thus, the final analysis was performed in 269 subjects.

The patients were interviewed by a physician who completed a standard record form

Results

Of the 269 patients included in the study, 220 had evidence of AMI on the basis of the aforementioned criteria. The other 49 subjects were used as a control group. Of these, 32 manifested signs of unstable angina, 10 had chronic ischemic heart disease, and 7 had nonischemic diseases. The 2 groups were balanced for age and sex. Nitrates, antiplatelets, and anticoagulants were more frequently used in the patients with AMI (P = .006, P = .008 and P < .0001, respectively), and calcium-channel

CRP and congestive heart failure

Although several data support the role of inflammatory response in long-term clinical events in AMI,4, 5, 6 data defining the association between baseline CRP elevation and subsequent development of heart failure within this clinical entity is limited. A correlation between peak CRP levels and mortality from heart failure was described in 2 studies performed in small groups.13, 21 To our knowledge, the present study is the first to highlight the relationship between baseline CRP and occurrence

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